Your VSP Vision Benefits Summary AUTOMOBILE CLUB OF SOUTHERN CALIFORNIA and VSP provide you with a choice of affordable vision plans. Choose the eye care essentials, or upgrade to give your eyes extra love.
PROVIDER NETWORK: VSP Choice EFFECTIVE DATE: 01/01/2024
BENEFIT
DESCRIPTION
COPAY
BENEFIT
DESCRIPTION
COPAY
Basic Coverage with a VSP Provider
Buy Up Coverage with a VSP Provider
Focuses on your eyes and overall wellness
$10
Focuses on your eyes and overall wellness
$10
WELLVISION EXAM
WELLVISION EXAM
Routine retinal screening
Up to $39
Routine retinal screening
Up to $39
Every 12 months
Every 12 months
Retinal imaging for members with diabetes covered-in-full Additional exams and services beyond routine care to treat immediate issues from pink eye to sudden changes in vision or to monitor ongoing conditions such as dry eye, diabetic eye disease, glaucoma, and more. Coordination with your medical coverage may apply. Ask your VSP network doctor for details.
Retinal imaging for members with diabetes covered-in-full Additional exams and services beyond routine care to treat immediate issues from pink eye to sudden changes in vision or to monitor ongoing conditions such as dry eye, diabetic eye disease, glaucoma, and more. Coordination with your medical coverage may apply. Ask your VSP network doctor for details.
$20 per exam
$20 per exam
ESSENTIAL MEDICAL EYE CARE
ESSENTIAL MEDICAL EYE CARE
Available as needed
Available as needed
PRESCRIPTION GLASSES
$15
PRESCRIPTION GLASSES
$10
$150 Enhanced Featured Frame Brands allowance 20% savings on the amount over your allowance $130 Walmart/Sam's Club frame allowance $130 frame allowance
$195 Enhanced Featured Frame Brands allowance 20% savings on the amount over your allowance $175 frame allowance
Included in Prescription Glasses
Included in Prescription Glasses
FRAME ⁺
FRAME ⁺
$175 Walmart/Sam's Club frame allowance $100 Costco frame allowance
$70 Costco frame allowance
Every 24 months
Every 12 months
Single vision, lined bifocal, and lined trifocal lenses Impact-resistant lenses for dependent children
Single vision, lined bifocal, and lined trifocal lenses Impact-resistant lenses for dependent children
Included in Prescription Glasses
Included in Prescription Glasses
LENSES
LENSES
Every 12 months
Every 12 months
Standard progressive lenses Premium progressive lenses Custom progressive lenses
$0
Standard progressive lenses Premium progressive lenses Custom progressive lenses
$0
$95 - $105 $150 - $175
$95 - $105 $150 - $175
LENS ENHANCEMENTS
LENS ENHANCEMENTS
Average savings of 30% on other lens enhancements
Tints/Light-reactive lenses Average savings of 30% on other lens enhancements
$0
Every 12 months
Every 12 months
$130 allowance for contacts; copay does not apply
CONTACTS (INSTEAD OF GLASSES)
$175 allowance for contacts; copay does not apply
Up to $60
CONTACTS (INSTEAD OF GLASSES)
Contact lens exam (fitting and evaluation)
Up to $60
Contact lens exam (fitting and evaluation)
Every 12 months
Every 12 months
Glasses and Sunglasses
Discover all current eyewear offers and savings at vsp.com/offers . 20% savings on unlimited additional pairs of prescription or non-prescription glasses/sunglasses, including lens enhancements, from a VSP provider within 12 months of your last WellVision Exam. Laser Vision Correction Average of 15% off the regular price; discounts available at contracted facilities. Exclusive Member Extras for VSP Members Contact lens rebates, lens satisfaction guarantees, and more offers at vsp.com/offers . Save up to 60% on digital hearing aids with TruHearing®. Visit vsp.com/offers /special-offers/hearing-aids for details. Enjoy everyday savings on health, wellness, and more with VSP Simple Values.
ADDITIONAL SAVINGS
YOUR COVERAGE GOES FURTHER IN-NETWORK With so many in-network choices, VSP makes it easy to get the most out of your benefits. You ’ ll have access to preferred private practice, retail, and online in-network choices. Log in to vsp.com to find an in-network provider.
† Only available to VSP members with applicable plan benefits. Frame brands and promotions are subject to change. ‡ Savings based on doctor ’ s retail price and vary by plan and purchase selection; average savings determined after benefits are applied. Ask your VSP network doctor for more details. +Coverage with a retail chain may be different or not apply.
VSP guarantees member satisfaction from VSP providers only. Coverage information is subject to change. In the event of a conflict between this information and your organization ’ s contract with VSP, the terms of the contract will prevail. Based on applicable laws, benefits may vary by location. In the state of Washington, VSP Vision Care, Inc., is the legal name of the corporation through which VSP does business. TruHearing is not available directly from VSP in the states of California and Washington. Premier Edge is not available for some members in the state of Texas. To learn about your privacy rights and how your protected health information may be used, see the VSP Notice of Privacy Practices on vsp.com . ©2024 Vision Service Plan. All rights reserved. VSP, Eyeconic, and WellVision Exam are registered trademarks, and VSP LightCare and VSP Premier Edge are trademarks of Vision Service Plan. Flexon and Dragon are registered trademarks of Marchon Eyewear, Inc. All other brands or marks are the property of their respective owners. 102898 VCCM Classification: Restricted
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